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Hartford’s preschool dental program
Hartford’s preschool dental program L eon a id F. M en czer, D .D .S.,
Since dental caries is a universal disease and a universal problem , it is only through caries prevention and control that this disease can be contained. Be cause caries activity is greatest in chil dren, the problem should be attacked at this age level, starting, preferably, with the preschool child. Approxim ately 10 per cent o f the population in the average com m unity is made up o f preschool children, aged two through six. I f the present dental m an pow er cou ld and w ould give this pre school grou p com plete dental treatment with subsequent routine maintenance service, and each year added to this group the children w h o becom e two years o f age, there w ould be few dental cripples when these children reached the late teens or the years beyond. Unless this type o f program or a com parable program is initiated, or unless dental caries is elimi nated through preventive measures, the num ber o f dental cripples in this country will grow increasingly greater. T h ou gh m any comm unities make den tal care available to the preschool child through public or privately endowed clinics, this service is usually incidental to a larger program o f treatment for children o f school age. T h e H artford H ealth D epartm ent, however, has de veloped a public dental health and clinical program which is devoted solely to the dental needs o f the preschool age group.
P U B L IC
H artford, Conn.
H E A L T H
P H A S E
T he H artford H ealth Departm ent’s pro gram annually reaches the parents of every three year old child, through a health education letter, attractively d eco rated, and m ailed during the m onth o f the child’s third birthday. Approxim ately 4,000 such letters are mailed each year. This letter stresses the im portance of early dental care and the need for periodic visits to the fam ily dentist, ade quate diet, the elimination o f sweets, the desirability o f toothbrushing immediately after eating and the need fo r fluoridation. This letter is designed to motivate parents to seek dental care for themselves as well as fo r their children. This initial letter is follow ed by a sec ond message which is distributed annually to all pu blic and parochial kindergarten children late in each school year. This message calls the parents’ attention to the im portance o f the first permanent molars and to the need fo r early treatment o f developm ental defects and carious lesions. In addition it repeats the inform ation contained in the first letter. In addition to these efforts, each nursery school, day-care center, and Sun day S ch ool is either visited or written several times during each school year in an attempt to familiarize the preschool
P u b lic h e a lt h p a rt m e n t .
698
d e n tist,
C it y
of
H a rtfo rd
h e a lth
de
M EN CZER . . . VO LUM E 52, JU N E 1756 • 699
child, his parents and his teachers with the desirability o f g ood dental health and the steps to be taken to preserve it. Finally, through talks to professional and lay groups, through the use o f mass media, and through actual demonstra tion o f preschool dental treatment in the health departm ent’s clinical facilities, the com m unity as well as the individual par ent is m ade aware o f the im portance o f early preventive measures. Every effort is m ade to apply practically the ap propriate technics o f learning through all the media o f com m unication available. C L IN IC A L
P H A S E
T he preschool clinical program operates in con ju n ction with the W ell-C hild C on ference o f the H artford Health D epart ment. Its purpose, like that o f the C on ference, is to provide a dental program for well children o f low incom e families as an additional means o f im proving child health. Essentially, the clinical program con sists o f fou r phases: 1. D ental health education ,2. Prophylaxis and examination 3. T op ica l fluoride applications 4. D ental correction D uring the calendar year o f 1954, 2,455 individual patients were treated in 9,420 patient visits. W eekly lists o f new patients are re ceived from the W ell-C hild C onference. Every child, on reaching tw o and one half years o f age, is referred to the den tal facility. O n receipt o f the child’s name, an appointm ent is m ade within a week to ten days. A t the patient’s first visit, a m edical history is obtained from the parent, and. significant m edical data is recorded on the child’ s record card. A fter an introduction to the personnel, surroundings and equipm ent, the child is given a dental prophylaxis, dental exam ination and the first o f fou r topical fluoride treatments. At the first o f these
visits, the dental hygienist explains the purpose o f early dental care and the value o f topical fluorides. D uring the sec ond visit she discusses the relation of nutrition to dental health and especially the harm ful effects o f sweets. A t the third visit she gives instruction in toothbrushing and m outh hygiene including instruc tion in the use o f dental floss. T h e fourth visit is used fo r review. By providing dental education as well as dental service, each visit is made to serve a dual purpose. I f the child is too young, either b e cause o f chronological age or em otional developm ent, to cooperate with the den tist, dental services are postponed for three months, at which time treatment is again attempted. D ental service is provided in three treatment rooms, two o f which are staffed by full-tim e dental hygienists conducting the preventive aspects o f the work. T he third room is staffed by a full-time dental assistant and ten part-tim e dentists, who also con duct their own private practices. T h e d octor’s schedule is arranged so that operative services are provided on a fu ll time basis just as is the preventive work. T h e clinic hours are from 9 a . m . to 12 noon and from 1 p . m . to 4 p . m . O n the com pletion o f the preventive phases o f the program , the children need ing restorative work are referred to the restorative clinic where they receive weekly appointments until all necessary w ork is com pleted. W eekly appointments are scheduled fo r the same day and hour which reduces the num ber o f each ch ild’s visits and also the num ber o f forgotten appointments. C om plete restorative service is p ro vided including pulp capping, amalgam restorations, extractions and space maintainers. T h e child sees the same doctor each week so that, psychologically, his re peated experiences are as pleasant as possible. Thus, the treatment received by the child in the public dental facility is almost identical to that which he would
700 • THE JO U R N A L O F THE A M ER IC A N DENTAL A SSO C IA TIO N
receive in the office o f a private dental practitioner. Children not in need of restorative work and children whose restorative work has been com pleted are recalled routinely every five to six months for follow -up supervision until the eruption o f the first permanent molars or entrance into the first grade, whichever is later. A t this time, the second series o f topical fluoride treatments are given to provide further protection to the deciduous teeth and, equally im portant, to give initial p ro tection to the newly erupted first perm a nent molars. A ll developm ental defects in the first permanent molars are then treated (prophylactic od on totom y) and all carious lesions corrected. T h e child then becom es ineligible for further care. As a final follow -u p procedure, ap proximately six months after the child becomes ineligible, his parents receive a dental reminder form stressing the need for continued periodic care and urging that the treatment be obtained from a dentist in private practice or at another public dental facility. A ll preventive and restorative treat ment is scheduled on an appointment basis so that patients arrive at intervals throughout the day. N ot only is this g ood office management, but more im portant, the children are ushered into the operatory prom ptly on their arrival. Thus they d o not experience the fatigue o f waiting which might intensify their apprehension regarding dental service. A n attractive waiting room with chil dren’s furniture, toys, dolls, tropical fish and recorded music aids in the child’ s pleasant adjustment to his clinical expe riences, thereby making dental therapy m ore acceptable. O B JE C T S
O F
PRO G RAM
From both a public health and clinical viewpoint, the objects o f this program are to: 1. Arouse a mouth hygiene conscious
ness in the com m unity for the preschool age child. 2. Create a dem and fo r better den tistry, especially fo r young children. 3. Dem onstrate the possibility o f pre venting or diminishing dental diseases through early care supplemented by health education. 4. Emphasize the preventive side of dentistry rather than corrective side through the application o f early preven tive and restorative measures, which thereby diminishes the need fo r future restorative dental work. 5. Provide a training center in pre school dentistry fo r recent dental grad uates. E ach year, each dental graduate who intends to practice locally is invited to work at this clinic one session a week for at least six months. This affords him an opportunity to acquire experience in child m anagem ent; to learn to operate from a seated position as an operating stool is available and everyone is re quested to use it; to learn the value of a properly trained assistant and how to utilize her services effectively and, finally, to be exposed to methods and technics of pedodontics and child management that he may not have acquired at dental school. 6 . Dem onstrate the most econom ical m ethod o f carrying on the type o f dental program which seems to be required under present day conditions for indigent groups. 7. M ake dental service available to indigents. O B S E R V A T IO N S
There is very little data available on the dental needs o f preschool children— specifically, d ef rates, percentage o f pre school children in need o f dental care, number o f visits for com pletion o f initial and maintenance needs, and the num ber o f children in need o f space maintainers. Tables 1 to 4 may help to shed some light on these matters. Dental findings in
M EN CZER . . . V O L U M E 52, JU N E 1954 • 701
this group, however, are not necessarily representative o f all preschool children since these children ( 1) cam e from families in the low incom e bracket and ( 2 ) the parents volunteered for the serv ice. These two factors, however, may not be sufficient to change the over-all p ic ture markedly. T able 1 illustrates def rates and per centage o f children in need o f dental care by age. A lthough these observations d o not include roentgenographic exam i nation, they are, fo r all practical pu r poses, accurate. T w enty-tw o and six tenths per cent o f the tw o year o ld ch il dren have 4.3 involved deciduous teeth, whereas 83.4 per cent o f the six year old children have 6.5 involved deciduous teeth. Tables 2 and 3 provide inform ation concerning the num ber o f patient visits necessary to com plete the required serv ices for the children listed in T a b le 1. These figures (T ables 2 and 3) represent only those children w ho cam e weekly and regularly until all needs were com pleted. T h e tables d o not relate the story o f a second group o f children w ho cam e re peatedly but whose total needs were not met because o f failure to attend the clinic a sufficient num ber o f times fo r com p le tion. Proportionately, dental service for more children was com pleted in the group that needed less attention than in the group that required m ore attention. This fact tends to distort the average num ber o f visits required to com plete the services fo r each child. In addition, deciduous anterior teeth were not treated in chil dren fou r years o f age or older because of the backlog o f patients. T h e num ber o f visits needed to com plete the required dental service fo r a child is dependent in part on the coopera tion and degree o f tolerance o f the p a tient. T hree year old children, and those younger, will tolerate treatment fo r 20 to 30 minutes. Five and six year old chil dren, when properly trained, are more
T a b le
1
• D e f ro te s a n d p e rc e n ta g e
o f c h i l d r e n w it h
i n v o l v e d d e c i d u o u s t e e t h b y a g e — f r o m c lin ic a l o b s e r v a t i o n s o f 2 , 4 5 5 p a t ie n t s t r e a t e d in 1 9 5 4
N o. of
N o. of
N o . of
pts.
pts. w ith
def
e x a m in e d
d e f t e e th
t e e th
Age
C h ild r e n Def
w it h d e f
ra te
t e e th
%
2
301
67
292
4 .3
22 .6
3
744
282
1 ,4 5 5
5 .2
37 .9
4
677
438
2 ,3 7 1
5 .4
6 4 .7
5
576
43 1
2,4 46
5.7
6
157
131
849
T a b le
76 .5
6.5
8 3 .4
2 • N u m b e r o f d e n t a l v is it s n e c e s s a r y f o r c o m
p le t i o n o f a c c u m u la t e d d e n t a l n e e d s o f p r e s c h o o l a g e c h ild r e n , b y a g e N o . o f pts. w h o se d e n tal
Age
n e e d s w e re c o m p le t e d
N o . o f v is it s fo r c o m p l e t io n
A v e ra g e no. o f v is it s f o r c o m p le t io n p e r c h ild
2
28
61
2 .2
3
16 7
545
3 .9
4
229
1 ,0 1 2
4.4
151
694
4 .6
23
144
6 .2
5
.
6
T a b le
3
• N u m b e r o f d e n t a l v is it s f o r c o m p l e t io n o f
m a in t e n a n c e d e n t a l n e e d s f o r p r e s c h o o l c h ild r e n , b y a g e N o . o f pts. Age
w h o se d e n tal n e e d s w e re c o m p le t e d
N o . o f v is it s fo r c o m p l e t io n
A v e ra g e no o f v is it s f o r c o m p l e t io n p e r c h ild .
3
26
60
2.3
4
11 8
309
2 .6
5
181
504
2.8
6
67
17 2
2 .6
cooperative and will tolerate 30 to 45 minute operative periods. T h e num ber o f visits required to p ro vide maintenance care is approximately the same regardless o f the child’s age (T a b le 3) as m ore work is done at each visit for the older children ( ages 4, 5 and 6 ) and less fo r the younger children ( ages 3 and 4 ) resulting in an average o f 2.5 visits per child. T h e num ber o f extracted second de-
702 • TH E JO U R N A L O F TH E A M ER IC A N DENTAL A SSO C IA TIO N
Table 4
•
E x t r a c t e d ( o r i n d ic a t e d f o r e x t r a c t io n ) s e c o n d d e c i d u o u s m o la r s
in p r e s c h o o l a g e c h i ld r e n b y a g e f r o m a m o n g 2 , 4 5 5 p a t ie n t s t r e a t e d in 1 9 5 4
N o . o f c h i ld r e n w it h 1 o r m o r e Age
N o. of
se c o n d ,d e c id u
c h i ld r e n
o u s m o la r s
tre a te d
e x tra cte d o r
N o . o f 2nd d e c id u o u s
m o la r s
e x tra c te d
i n d ic a t e d f o r
C h i l d r e n w it h 1 o r m o re d e c id u o u s m o la r s e xtra cte d — %
e x t r a c t io n
30 1 744
0 6
0
0
15
677
38
58
5.6
576
85
123
14.9
157
58
112
36 .9
ciduous molars or those indicated for extraction am ong the 2,455 preschool children in this study is shown in T able 4. T h e num ber o f children in this study with lost second deciduous molars is startling since these youngsters received somewhat regular and periodic dental care and therefore d o not represent the great group o f dentally neglected pre school children. These observations point up the need fo r the application o f all known caries preventives, the need for beginning dental care when the children are between the ages o f tw o and three and fo r com plete m aintenance service thereafter at frequent and regular inter vals. S U M M A R Y
Caries am ong preschool children is an enormous public health problem . T h e so
lution o f this problem lies in caries pre ventive measures and early treatment, the latter to begin between the ages o f two and three, to be follow ed frequently and periodically thereafter by g ood care. T en per cent o f the population o f the average com m unity is com posed o f pre school children. Children in this group must be included in the practice o f the general practitioner. Failure to d o so co n tributes considerably to the growing group o f dental cripples found in every generation. T h e public health and clinical phases o f a preschool dental program as pres ently operated in a comm unity o f ap proxim ately 185,000 is discussed. Statistical data with regard to def rates, dental visits necessary fo r com ple tion o f cumulative and maintenance den tal needs, as well as data on lost second deciduous molars is presented.
T h e A im o f Living • N ot perfection as a final goal, but the never-ending process of perfecting, maturing, refining, is the aim in living. . . . T h e bad man is the man w ho, no matter how good he has been, is beginning to deteriorate, to grow less good. T h e g ood man is the m an w ho, no matter how m orally unworthy he has been, is m oving to becom e better. Such a conception makes one severe in ju dging himself and humane in ju dging others. John D ew ey, Reconstruction in Philosophy.
Since dental caries is a universal disease and a universal problem , it is only through caries prevention and control that this disease can be contained. Be cause caries activity is greatest in chil dren, the problem should be attacked at this age level, starting, preferably, with the preschool child. Approxim ately 10 per cent o f the population in the average com m unity is made up o f preschool children, aged two through six. I f the present dental m an pow er cou ld and w ould give this pre school grou p com plete dental treatment with subsequent routine maintenance service, and each year added to this group the children w h o becom e two years o f age, there w ould be few dental cripples when these children reached the late teens or the years beyond. Unless this type o f program or a com parable program is initiated, or unless dental caries is elimi nated through preventive measures, the num ber o f dental cripples in this country will grow increasingly greater. T h ou gh m any comm unities make den tal care available to the preschool child through public or privately endowed clinics, this service is usually incidental to a larger program o f treatment for children o f school age. T h e H artford H ealth D epartm ent, however, has de veloped a public dental health and clinical program which is devoted solely to the dental needs o f the preschool age group.
P U B L IC
H artford, Conn.
H E A L T H
P H A S E
T he H artford H ealth Departm ent’s pro gram annually reaches the parents of every three year old child, through a health education letter, attractively d eco rated, and m ailed during the m onth o f the child’s third birthday. Approxim ately 4,000 such letters are mailed each year. This letter stresses the im portance of early dental care and the need for periodic visits to the fam ily dentist, ade quate diet, the elimination o f sweets, the desirability o f toothbrushing immediately after eating and the need fo r fluoridation. This letter is designed to motivate parents to seek dental care for themselves as well as fo r their children. This initial letter is follow ed by a sec ond message which is distributed annually to all pu blic and parochial kindergarten children late in each school year. This message calls the parents’ attention to the im portance o f the first permanent molars and to the need fo r early treatment o f developm ental defects and carious lesions. In addition it repeats the inform ation contained in the first letter. In addition to these efforts, each nursery school, day-care center, and Sun day S ch ool is either visited or written several times during each school year in an attempt to familiarize the preschool
P u b lic h e a lt h p a rt m e n t .
698
d e n tist,
C it y
of
H a rtfo rd
h e a lth
de
M EN CZER . . . VO LUM E 52, JU N E 1756 • 699
child, his parents and his teachers with the desirability o f g ood dental health and the steps to be taken to preserve it. Finally, through talks to professional and lay groups, through the use o f mass media, and through actual demonstra tion o f preschool dental treatment in the health departm ent’s clinical facilities, the com m unity as well as the individual par ent is m ade aware o f the im portance o f early preventive measures. Every effort is m ade to apply practically the ap propriate technics o f learning through all the media o f com m unication available. C L IN IC A L
P H A S E
T he preschool clinical program operates in con ju n ction with the W ell-C hild C on ference o f the H artford Health D epart ment. Its purpose, like that o f the C on ference, is to provide a dental program for well children o f low incom e families as an additional means o f im proving child health. Essentially, the clinical program con sists o f fou r phases: 1. D ental health education ,2. Prophylaxis and examination 3. T op ica l fluoride applications 4. D ental correction D uring the calendar year o f 1954, 2,455 individual patients were treated in 9,420 patient visits. W eekly lists o f new patients are re ceived from the W ell-C hild C onference. Every child, on reaching tw o and one half years o f age, is referred to the den tal facility. O n receipt o f the child’s name, an appointm ent is m ade within a week to ten days. A t the patient’s first visit, a m edical history is obtained from the parent, and. significant m edical data is recorded on the child’ s record card. A fter an introduction to the personnel, surroundings and equipm ent, the child is given a dental prophylaxis, dental exam ination and the first o f fou r topical fluoride treatments. At the first o f these
visits, the dental hygienist explains the purpose o f early dental care and the value o f topical fluorides. D uring the sec ond visit she discusses the relation of nutrition to dental health and especially the harm ful effects o f sweets. A t the third visit she gives instruction in toothbrushing and m outh hygiene including instruc tion in the use o f dental floss. T h e fourth visit is used fo r review. By providing dental education as well as dental service, each visit is made to serve a dual purpose. I f the child is too young, either b e cause o f chronological age or em otional developm ent, to cooperate with the den tist, dental services are postponed for three months, at which time treatment is again attempted. D ental service is provided in three treatment rooms, two o f which are staffed by full-tim e dental hygienists conducting the preventive aspects o f the work. T he third room is staffed by a full-time dental assistant and ten part-tim e dentists, who also con duct their own private practices. T h e d octor’s schedule is arranged so that operative services are provided on a fu ll time basis just as is the preventive work. T h e clinic hours are from 9 a . m . to 12 noon and from 1 p . m . to 4 p . m . O n the com pletion o f the preventive phases o f the program , the children need ing restorative work are referred to the restorative clinic where they receive weekly appointments until all necessary w ork is com pleted. W eekly appointments are scheduled fo r the same day and hour which reduces the num ber o f each ch ild’s visits and also the num ber o f forgotten appointments. C om plete restorative service is p ro vided including pulp capping, amalgam restorations, extractions and space maintainers. T h e child sees the same doctor each week so that, psychologically, his re peated experiences are as pleasant as possible. Thus, the treatment received by the child in the public dental facility is almost identical to that which he would
700 • THE JO U R N A L O F THE A M ER IC A N DENTAL A SSO C IA TIO N
receive in the office o f a private dental practitioner. Children not in need of restorative work and children whose restorative work has been com pleted are recalled routinely every five to six months for follow -up supervision until the eruption o f the first permanent molars or entrance into the first grade, whichever is later. A t this time, the second series o f topical fluoride treatments are given to provide further protection to the deciduous teeth and, equally im portant, to give initial p ro tection to the newly erupted first perm a nent molars. A ll developm ental defects in the first permanent molars are then treated (prophylactic od on totom y) and all carious lesions corrected. T h e child then becom es ineligible for further care. As a final follow -u p procedure, ap proximately six months after the child becomes ineligible, his parents receive a dental reminder form stressing the need for continued periodic care and urging that the treatment be obtained from a dentist in private practice or at another public dental facility. A ll preventive and restorative treat ment is scheduled on an appointment basis so that patients arrive at intervals throughout the day. N ot only is this g ood office management, but more im portant, the children are ushered into the operatory prom ptly on their arrival. Thus they d o not experience the fatigue o f waiting which might intensify their apprehension regarding dental service. A n attractive waiting room with chil dren’s furniture, toys, dolls, tropical fish and recorded music aids in the child’ s pleasant adjustment to his clinical expe riences, thereby making dental therapy m ore acceptable. O B JE C T S
O F
PRO G RAM
From both a public health and clinical viewpoint, the objects o f this program are to: 1. Arouse a mouth hygiene conscious
ness in the com m unity for the preschool age child. 2. Create a dem and fo r better den tistry, especially fo r young children. 3. Dem onstrate the possibility o f pre venting or diminishing dental diseases through early care supplemented by health education. 4. Emphasize the preventive side of dentistry rather than corrective side through the application o f early preven tive and restorative measures, which thereby diminishes the need fo r future restorative dental work. 5. Provide a training center in pre school dentistry fo r recent dental grad uates. E ach year, each dental graduate who intends to practice locally is invited to work at this clinic one session a week for at least six months. This affords him an opportunity to acquire experience in child m anagem ent; to learn to operate from a seated position as an operating stool is available and everyone is re quested to use it; to learn the value of a properly trained assistant and how to utilize her services effectively and, finally, to be exposed to methods and technics of pedodontics and child management that he may not have acquired at dental school. 6 . Dem onstrate the most econom ical m ethod o f carrying on the type o f dental program which seems to be required under present day conditions for indigent groups. 7. M ake dental service available to indigents. O B S E R V A T IO N S
There is very little data available on the dental needs o f preschool children— specifically, d ef rates, percentage o f pre school children in need o f dental care, number o f visits for com pletion o f initial and maintenance needs, and the num ber o f children in need o f space maintainers. Tables 1 to 4 may help to shed some light on these matters. Dental findings in
M EN CZER . . . V O L U M E 52, JU N E 1954 • 701
this group, however, are not necessarily representative o f all preschool children since these children ( 1) cam e from families in the low incom e bracket and ( 2 ) the parents volunteered for the serv ice. These two factors, however, may not be sufficient to change the over-all p ic ture markedly. T able 1 illustrates def rates and per centage o f children in need o f dental care by age. A lthough these observations d o not include roentgenographic exam i nation, they are, fo r all practical pu r poses, accurate. T w enty-tw o and six tenths per cent o f the tw o year o ld ch il dren have 4.3 involved deciduous teeth, whereas 83.4 per cent o f the six year old children have 6.5 involved deciduous teeth. Tables 2 and 3 provide inform ation concerning the num ber o f patient visits necessary to com plete the required serv ices for the children listed in T a b le 1. These figures (T ables 2 and 3) represent only those children w ho cam e weekly and regularly until all needs were com pleted. T h e tables d o not relate the story o f a second group o f children w ho cam e re peatedly but whose total needs were not met because o f failure to attend the clinic a sufficient num ber o f times fo r com p le tion. Proportionately, dental service for more children was com pleted in the group that needed less attention than in the group that required m ore attention. This fact tends to distort the average num ber o f visits required to com plete the services fo r each child. In addition, deciduous anterior teeth were not treated in chil dren fou r years o f age or older because of the backlog o f patients. T h e num ber o f visits needed to com plete the required dental service fo r a child is dependent in part on the coopera tion and degree o f tolerance o f the p a tient. T hree year old children, and those younger, will tolerate treatment fo r 20 to 30 minutes. Five and six year old chil dren, when properly trained, are more
T a b le
1
• D e f ro te s a n d p e rc e n ta g e
o f c h i l d r e n w it h
i n v o l v e d d e c i d u o u s t e e t h b y a g e — f r o m c lin ic a l o b s e r v a t i o n s o f 2 , 4 5 5 p a t ie n t s t r e a t e d in 1 9 5 4
N o. of
N o. of
N o . of
pts.
pts. w ith
def
e x a m in e d
d e f t e e th
t e e th
Age
C h ild r e n Def
w it h d e f
ra te
t e e th
%
2
301
67
292
4 .3
22 .6
3
744
282
1 ,4 5 5
5 .2
37 .9
4
677
438
2 ,3 7 1
5 .4
6 4 .7
5
576
43 1
2,4 46
5.7
6
157
131
849
T a b le
76 .5
6.5
8 3 .4
2 • N u m b e r o f d e n t a l v is it s n e c e s s a r y f o r c o m
p le t i o n o f a c c u m u la t e d d e n t a l n e e d s o f p r e s c h o o l a g e c h ild r e n , b y a g e N o . o f pts. w h o se d e n tal
Age
n e e d s w e re c o m p le t e d
N o . o f v is it s fo r c o m p l e t io n
A v e ra g e no. o f v is it s f o r c o m p le t io n p e r c h ild
2
28
61
2 .2
3
16 7
545
3 .9
4
229
1 ,0 1 2
4.4
151
694
4 .6
23
144
6 .2
5
.
6
T a b le
3
• N u m b e r o f d e n t a l v is it s f o r c o m p l e t io n o f
m a in t e n a n c e d e n t a l n e e d s f o r p r e s c h o o l c h ild r e n , b y a g e N o . o f pts. Age
w h o se d e n tal n e e d s w e re c o m p le t e d
N o . o f v is it s fo r c o m p l e t io n
A v e ra g e no o f v is it s f o r c o m p l e t io n p e r c h ild .
3
26
60
2.3
4
11 8
309
2 .6
5
181
504
2.8
6
67
17 2
2 .6
cooperative and will tolerate 30 to 45 minute operative periods. T h e num ber o f visits required to p ro vide maintenance care is approximately the same regardless o f the child’s age (T a b le 3) as m ore work is done at each visit for the older children ( ages 4, 5 and 6 ) and less fo r the younger children ( ages 3 and 4 ) resulting in an average o f 2.5 visits per child. T h e num ber o f extracted second de-
702 • TH E JO U R N A L O F TH E A M ER IC A N DENTAL A SSO C IA TIO N
Table 4
•
E x t r a c t e d ( o r i n d ic a t e d f o r e x t r a c t io n ) s e c o n d d e c i d u o u s m o la r s
in p r e s c h o o l a g e c h i ld r e n b y a g e f r o m a m o n g 2 , 4 5 5 p a t ie n t s t r e a t e d in 1 9 5 4
N o . o f c h i ld r e n w it h 1 o r m o r e Age
N o. of
se c o n d ,d e c id u
c h i ld r e n
o u s m o la r s
tre a te d
e x tra cte d o r
N o . o f 2nd d e c id u o u s
m o la r s
e x tra c te d
i n d ic a t e d f o r
C h i l d r e n w it h 1 o r m o re d e c id u o u s m o la r s e xtra cte d — %
e x t r a c t io n
30 1 744
0 6
0
0
15
677
38
58
5.6
576
85
123
14.9
157
58
112
36 .9
ciduous molars or those indicated for extraction am ong the 2,455 preschool children in this study is shown in T able 4. T h e num ber o f children in this study with lost second deciduous molars is startling since these youngsters received somewhat regular and periodic dental care and therefore d o not represent the great group o f dentally neglected pre school children. These observations point up the need fo r the application o f all known caries preventives, the need for beginning dental care when the children are between the ages o f tw o and three and fo r com plete m aintenance service thereafter at frequent and regular inter vals. S U M M A R Y
Caries am ong preschool children is an enormous public health problem . T h e so
lution o f this problem lies in caries pre ventive measures and early treatment, the latter to begin between the ages o f two and three, to be follow ed frequently and periodically thereafter by g ood care. T en per cent o f the population o f the average com m unity is com posed o f pre school children. Children in this group must be included in the practice o f the general practitioner. Failure to d o so co n tributes considerably to the growing group o f dental cripples found in every generation. T h e public health and clinical phases o f a preschool dental program as pres ently operated in a comm unity o f ap proxim ately 185,000 is discussed. Statistical data with regard to def rates, dental visits necessary fo r com ple tion o f cumulative and maintenance den tal needs, as well as data on lost second deciduous molars is presented.
T h e A im o f Living • N ot perfection as a final goal, but the never-ending process of perfecting, maturing, refining, is the aim in living. . . . T h e bad man is the man w ho, no matter how good he has been, is beginning to deteriorate, to grow less good. T h e g ood man is the m an w ho, no matter how m orally unworthy he has been, is m oving to becom e better. Such a conception makes one severe in ju dging himself and humane in ju dging others. John D ew ey, Reconstruction in Philosophy.